THE NATION

A Proactive Prostate Cancer Stand

A study encourages aggressive treatment for younger patients over a 'wait-and-see' approach.

Men in their 60s or younger who have early prostate cancer should be intensively treated with radiation therapy or prostate surgery instead of with a watch-and-wait approach, according to one of the longest studies of the disease.

The report, published today in the Journal of the American Medical Assn., found in a study of 223 men that after 15 years, low-grade prostate cancers began growing more aggressively, causing a significantly greater death rate after that point compared with the first 15 years of the study.

Treatment of prostate cancer has long been debated among doctors because the cancer is slow-growing and predominantly affects older men who could die of other causes before the cancer killed them.

Today's study suggests patients need aggressive treatment if they have a good chance of living 15 years or longer, the authors concluded. Dr. Jan-Erik Johansson of the Orebro University Hospital in Sweden was the lead author.

The 223 Swedish men in the study, with an average age of 72, all had a diagnosis of slow-growing, early-stage prostate cancer. They were tracked for an average of 21 years. The men were not treated for the disease but were given regular medical examinations to monitor the cancer's status.

By the end of the study period, the cancer had gotten worse in 89 patients, 39 of whom had cancer that had spread to other parts of the body.

Thirty-five men died of their cancers.

After the 15-year point, the rates of death and cancer progression jumped threefold, suggesting a biological change in the cells.

The American Cancer Society said prostate cancer was the most common cancer in U.S. men after skin cancer, killing nearly 30,000 annually.

The watch-and-wait approach has been favored by some doctors because prostate cancer is primarily a disease of old age and advances slowly. In addition, aggressive treatments, such as surgery to remove the prostate gland, can cause side effects such as impotence and incontinence.

More recently, watching and waiting is mostly confined to patients who are elderly or have medical complications that make surgery dangerous.

The study indicates that the movement toward more aggressive treatment has been appropriate, said Dr. Timothy Wilson, director of the prostate cancer program at the City of Hope Cancer Center in Duarte.

However, it adds another complication to deciding a treatment plan, said Dr. Charles E. Shapiro, staff urologist with the Kaiser Permanente Los Angeles Medical Center.

"There are no right answers with regard to prostate cancer," Shapiro said.